| Entity Name: | GENE WINDOM, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 25 Aug 2004 (20 years ago) |
| Document Number: | P04000122904 |
| FEI/EIN Number | 201535507 |
| Address: | 12302 ROPER BLVD, UNIT 106 & 107, CLERMONT, FL, 34711 |
| Mail Address: | 12302 ROPER BLVD, UNIT 106 & 107, CLERMONT, FL, 34711 |
| ZIP code: | 34711 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144334889 | 2006-08-19 | 2023-03-07 | 12302 ROPER BLVD, UNIT 106 & 107, CLERMONT, FL, 347118515, US | 12302 ROPER BLVD, UNIT 106 & 107, CLERMONT, FL, 347118515, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 352-243-6340 |
| Fax | 3522436596 |
Authorized person
| Name | MR. GENE WINDOM |
| Role | PRESIDENT |
| Phone | 3522436340 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | PH22192 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 031651200 |
| State | FL |
| Issuer | NCPDP # |
| Number | 1020558 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| GENE WINDOM INC 401K PLAN | 2013 | 201535507 | 2014-06-26 | GENE WINDOM INC | 2 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2014-06-26 |
| Name of individual signing | GENE WINDOM |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2012-01-01 |
| Business code | 446110 |
| Sponsor’s telephone number | 3522436340 |
| Plan sponsor’s address | 12221 REBECCAS RUN DR, WINTER GARDEN, FL, 34787 |
Signature of
| Role | Plan administrator |
| Date | 2014-06-26 |
| Name of individual signing | GENE WINDOM |
| Valid signature | Filed with authorized/valid electronic signature |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2012-01-01 |
| Business code | 446110 |
| Sponsor’s telephone number | 3522436340 |
| Plan sponsor’s address | 12221 REBECCAS RUN DR, WINTER GARDEN, FL, 34787 |
Signature of
| Role | Plan administrator |
| Date | 2014-04-16 |
| Name of individual signing | GENE WINDOM |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| WINDOM GENE | Agent | 12221 REBECCA'S RUN DRIVE, WINTER GARDEN, FL, 34787 |
| Name | Role | Address |
|---|---|---|
| WINDOM GENE | President | 12221 REBECCA'S RUN DRIVE, WINTER GARDEN, FL, 34787 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2017-05-01 | WINDOM, GENE | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2007-05-01 | 12302 ROPER BLVD, UNIT 106 & 107, CLERMONT, FL 34711 | No data |
| CHANGE OF MAILING ADDRESS | 2007-05-01 | 12302 ROPER BLVD, UNIT 106 & 107, CLERMONT, FL 34711 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-01 |
| ANNUAL REPORT | 2023-03-30 |
| ANNUAL REPORT | 2022-04-30 |
| ANNUAL REPORT | 2021-05-01 |
| ANNUAL REPORT | 2020-06-30 |
| ANNUAL REPORT | 2019-03-27 |
| ANNUAL REPORT | 2018-04-25 |
| ANNUAL REPORT | 2017-05-01 |
| ANNUAL REPORT | 2016-09-01 |
| ANNUAL REPORT | 2015-03-24 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
